SisterY: Acupuncture can be effective for controlling pain. Mechanism is unclear, but I believe there are trials already showing it works.

The study is based on change in a numeric scale for depression. If I had to make a guess, I would say the measuring instrument they are using is just not sensitive for important changes in peoples mood/behavior, rather than SSRIs don’t work. The drugs themselves have probably undergone more rigorous study than the measuring instrument. Also, the drugs have also probably undergone more thorough study than any alternative treatment.

“Why is “Overcoming Bias” perpetuating the pervasive anti-drug bias that keeps so many people from seeking treatment?”

Forgive me, I’m not very intelligent. Robin & others here present actual evidence that SSRIs don’t work for mild-to-moderate depression (the cases for which they are most often prescribed) and you describe this as anti-drug bias? Are you arguing a pro-drug bias is better? That we should take drugs even when they don’t work?

Robin is not arguing against treating dysthymia or moderate depression – the discussion might soon shift to what kind of treatments have been proven to work. The problem is in medicine, which is supposed to be scientific, society often pays through the nose for that which actually doesn’t have adequate scientific evidence behind its efficacy.

This is my 3rd comment, so I’m outta here. But please instead of so many chiming in with “I’m a happy placebo lover who believes in my impressive shaman-psychiatrist,” I’d be interested in seeing what has been proven to work for dysthymia, and if nothing has been studied, I’d like to hear commentators tell me why not.

I have a friend who has been suicidal on and off for months now, and I can’t convince her to go get help, precisely because of all this anti-drug bias and stigma. And the very fact that sertraline can cause manic episodes if you overdose or if you’ve got misdiagnosed manic-depression, tells me that there’s something real going on. Even if it IS a placebo effect, let’s figure out how to harness that power without the side-effects.

It might just be post hoc fallacy, but my attempts to go off medicine have always been followed fairly quickly by trouble (or, at least, what my parents call trouble). The only thing that I can identify as having any effect on me at all during my sophomore year of high school was the pills I was given. After all, life still sucked, but I now I was cheerful about it!

“things like tremors, abnormal sleepiness, and loss of sexual desire are mild.”

Clearly you’ve never talked to the wife of a guy on an SSRI long-term – now that’s depression. Dropping coffee cups everywhere and nodding off on the job or while driving really aren’t a party. But may I gently say it seems condescending of you to decide on your own authority that these issues are “mild” and should just be endured. Yikes!

@Doug S

“an effect that helps me somehow and they have some nasty withdrawal symptoms.”

Let me politely ask: are you saying you pay lots and lots of money to Big Pharma every year for an addictive substance with “nasty withdrawal symptoms” for an effect you can’t really describe? Does this mean you keep taking these expensive medications with unclear results simply to avoid the pain of withdrawal? I don’t mean to criticize, because I am sure you know what is best for you, but doesn’t something seem strange in this scenario?

Stuff like this moves me more and more towards Robin’s counter-intuitive “we have too much medicine” position.

(Technically, I’m taking an SNRI rather than an SSRI, but they’re similar enough.)

In summary: nope, that wasn’t in my statistics class.